Diabetes-related foot ulcers associated with high short-term mortality rates
In patients with a new diabetes-related foot ulcer, mortality rates were 4.2%, 8.2%, and 14.4% at 12, 26, and 52 weeks, and even higher rates were seen with cardiovascular or renal comorbidities or older age, a study in England and Wales found.
Short-term mortality appears to be high in patients with a new diabetes-related foot ulcer, a recent study found.
Researchers used data from the National Diabetes Foot Care Audit in England and Wales to evaluate mortality rates over the short term in patients who presented to a specialist with a new diabetic foot ulcer between April 2017 and March 2022. The study's primary outcomes were mortality rates at 12, 26, and 52 weeks after a patient's first expert assessment for a first registered foot ulcer. Patients were followed for 52 weeks or until death, whichever occurred first. The study results were published Sept. 27 by Diabetologia.
Among 71,000 patients, the median age was 71 years and 82.1% were White. Overall, 83.7% had type 2 diabetes, 13.4% had type 1 diabetes, and 2.9% had other or unknown diabetes types. Mortality rates at 12, 26, and 52 weeks were 4.2%, 8.2%, and 14.4%, respectively. Higher mortality rates at 26 weeks were associated with age (rate ratio, 2.15 [95% CI, 2.03 to 2.28] for age ≥80 years vs. ages 65 to 69 years) and documented evidence of lower-limb ischemia (rate ratio, 1.78; 95% CI, 1.69 to 1.88), as well as heart failure (rate ratio, 2.13; 95% CI, 2.00 to 2.26), myocardial infarction (rate ratio, 1.45; 95% CI, 1.29 to 1.63), stroke (rate ratio, 1.37; 95% CI, 1.22 to 1.53), renal replacement therapy (rate ratio, 2.34; 95% CI, 2.09 to 2.61), and stage 3 or greater chronic kidney disease (rate ratio, 1.20; 95% CI, 1.12 to 1.29). Ulcers with an area of 1 cm2 or greater, deep ulcers, and ulcers located on the hindfoot were also associated with higher mortality rates (rate ratios, 1.50 [95% CI, 1.42 to 1.59], 1.26 [95% CI, 1.18 to 1.35], and 1.53 [95% CI, 1.44 to 1.62], respectively). The 26-week mortality rate was higher than 25% for 7.3% of all patients, 11.5% of those ages 65 years and older, and 22.1% of those ages 80 years and older.
The researchers noted that they did not have accurate data on the total number of patients with a diabetes-related foot ulcer and could not be sure of the proportion included in the registry. They concluded that short-term mortality rates are very high in older patients with diabetes-related foot ulcers, particularly in those with cardiovascular or renal comorbidities, and that there is a clear association between mortality and ulcer position, area, and depth.
“Given that the 26-week mortality rate is greater than 25% for about 1 in 14 of all those presenting with a [diabetes-related foot ulcer] (rising to more than one in five of those aged 80 years and older), our analysis suggests that a palliative approach to foot ulcer management plan should be considered more frequently,” they wrote.